UW MEDICINE PATIENT EDUCATION Treatment with Rivaroxaban Xarelto This handout explains the medicine rivaroxaban, a drug that helps prevent blood clots. What is rivaroxaban? Rivaroxaban (brand name Xarelto) is an anticoagulant medicine. Anti means against, and coagulant refers to blood clotting. An anticoagulant helps prevent clots from forming in your blood. Although rivaroxaban is sometimes called a blood-thinner, it works by preventing a natural blood component, called factor Xa, from forming clots. It does not make your blood thinner. Why am I taking rivaroxaban? Your doctor has prescribed rivaroxaban to prevent harmful blood clots from forming. Many conditions can cause blood clots to form. For example, they can occur in people who have a heart condition called atrial fibrillation. In atrial fibrillation, part of the heart does not beat the way it should. This can make blood clots form within the heart. Parts of these clots can break off and travel to the brain. A blood clot in the brain can cause a stroke. Rivaroxaban lowers the chance of clots forming and causing a stroke. Blood clots may also form after surgery, including surgery to replace a hip or knee. Rivaroxaban is used to prevent these kinds of clots from forming. Rivaroxaban is also used to treat clots that have already formed in the veins of your legs (deep vein thrombosis), or in your lungs (pulmonary embolism), and to lower the risk of clots forming again. How does rivaroxaban work? Not being able to walk right after hip or knee replacement surgery raises your risk of getting a blood clot in your leg. Many things must happen inside the body for a blood clot to form. Natural parts of the blood called clotting factors are involved in each step of this process. Page 1 of 6 Treatment with Rivaroxaban
Rivaroxaban (Xarelto) is a medicine that is used to lower the risk of stroke in people who have atrial fibrillation. It is also used to treat blood clots in the legs and lungs, and to prevent blood clots after surgery. Your dose of rivaroxaban will depend on what you are taking it for. Your doctor will decide which dose is right for you. Take rivaroxaban at the same time each day. Take 10 mg tablets with or without food. Take 15 mg and 20 mg tablets with food. Tablets may be crushed if needed. Factor Xa is the clotting factor that rivaroxaban blocks. This prevents the clot from forming. Rivaroxaban can help stop clots from forming and can keep clots from getting larger, but it does not break up clots that are there already. How long does it take for rivaroxaban to work? Rivaroxaban begins to reduce blood clotting within a few hours after taking the first dose. If you stop taking rivaroxaban, its effects on clotting begin to wear off within 24 hours for most people. How much rivaroxaban should I take? Rivaroxaban comes in 10 mg, 15 mg, and 20 mg tablets. The dose, number of doses to take each day, and the time between each dose will be different for each person. It will depend on what you are taking rivaroxaban for and how well your kidneys are working. Your doctor will decide which dose is right for you. These are the most common doses: To prevent stroke and blood clots in atrial fibrillation: 15 mg or 20 mg once a day (with your evening meal). To prevent blood clots after surgery: 10 mg once a day (with or without food) for up to 1 month. The first dose is taken 6 to 10 hours after surgery. To treat blood clots: 15 mg twice a day (with food) for 21 days, then 20 mg once a day (with food) for at least 2 more months. How should I take rivaroxaban? Take rivaroxaban exactly as prescribed by your doctor, and at the same time each day. You can take the 10 mg tablets with or without food. You must take the 15 mg and 20 mg tablets with food. If you are taking rivaroxaban to prevent stroke in atrial fibrillation, take your dose with your evening meal. Rivaroxaban tablets can be crushed if needed. What should I do if I miss a dose? Try not to miss any doses of rivaroxaban. If you do miss a dose: If you take rivaroxaban once a day and remember the same day, take it as soon as you remember. If you take rivaroxaban twice a day, you may take two 15 mg tablets at the same time, but only on the day you missed your dose. Go back to taking one 15 mg tablet twice a day the next day. Page 2 of 6 Treatment with Rivaroxaban
Rivaroxaban does not require any routine blood testing. If you miss a full day of your doses, call your doctor or the anticoagulation clinic. If you cannot reach them, skip your missed doses and take your usual dose the next day at the normal time. If you take too much rivaroxaban, call your doctor right away or go to the nearest emergency room. Do not run out of rivaroxaban. Refill your prescription before you run out. The clot-fighting effects of rivaroxaban begin to wear off in about 24 hours. When to Call Your Doctor Call your doctor or go to the nearest emergency room right away if you have any of these symptoms: Sudden weakness in an arm or leg Sudden numbness or tingling anywhere in your body Changes in eyesight or not being able to see out of one or both eyes Suddenly having slurred speech or not being able to speak Dizziness or faintness New pain, swelling, redness, or heat in your arm, leg, or foot New shortness of breath or chest pain Do I need to have my blood tested while taking rivaroxaban? You do not need to have routine blood testing to check the amount of rivaroxaban in your body. But, some doses of rivaroxaban are based on how well your kidneys are working. Because of this, your doctor may want you to have a blood test from time to time to check the health of your kidneys. What are the side effects of rivaroxaban? Bleeding The most common and serious side effect of rivaroxaban is bleeding. Rivaroxaban can cause bleeding that can sometimes lead to death. Very minor bleeding may occur. This is normal, and it may cause any of these symptoms from time to time: Gums bleeding when you brush your teeth Nosebleeds Easy bruising More bleeding than normal from small cuts For women, longer or heavier menstrual bleeding Page 3 of 6 Treatment with Rivaroxaban
The most serious and common side effect of rivaroxaban is bleeding. But, call your doctor or come to the hospital emergency room right away if you: Have a serious fall or hit your head Have any of these symptoms of major bleeding: Red or dark brown urine Red or black, tarry stool Vomiting or coughing up blood Severe headache or stomachache Bruises that appear for no known reason Frequent nosebleeds, bleeding gums, or unusual bleeding Any bleeding that does not stop or is very heavy There is no medicine that can reverse the effects of rivaroxaban if you do start to bleed. Your doctor will treat you with blood transfusions and other methods. Other Side Effects There are other common side effects of rivaroxaban. If you have any of these symptoms and they are bothering you, ask your health care provider about things that can help. These symptoms include: Itching Pins and needles or a tingling feeling Blisters Increased fluid drainage from your surgery site (if you are taking rivaroxaban to prevent blood clots after surgery) Does rivaroxaban affect how any other medicines work? You may have a higher risk of bleeding if you take rivaroxaban and other medicines that also lower the blood s ability to form clots. Some of these medicines are: Aspirin or products that contain aspirin, such as Excedrin, Alka- Seltzer, Bayer, Bufferin, Nyquil, and Pepto-Bismol Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, and others), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), ketoprofen (Actron, Orudis), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn, and others), piroxicam (Feldene), and others Page 4 of 6 Treatment with Rivaroxaban
Call your doctor or the anticoagulation clinic whenever you start or stop any prescription or over-the-counter medicine, herbal product, or vitamin supplement. Drug interactions with rivaroxaban can increase your risk of bleeding. Warfarin (Coumadin) Any medicine that contains heparin Clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta) Dabigatran (Pradaxa), apixaban (Eliquis) If you are taking rivaroxaban, do NOT take any of these medicines without first checking with your doctor or anticoagulation clinic. Other drugs may also affect how rivaroxaban works in your body. It is very important to tell your doctor or anticoagulation clinic whenever you start or stop any medicine. This includes medicines you can buy without a prescription, herbal products, and vitamins. Is it safe to drink alcohol while taking rivaroxaban? It is best to avoid alcohol while taking rivaroxaban. This is because it can increase the risk of bleeding in your stomach and intestines. If you do drink alcohol, do not have more than 1 drink a day, and no more than 2 drinks at a time every now and then. (One drink = 1 beer, or 1 glass of wine, or 1 cocktail, or 1 shot.) Do I need to avoid eating certain foods while taking rivaroxaban? You can eat all types of foods if you take rivaroxaban. There are no eating restrictions. Should I limit activities while taking rivaroxaban? Since rivaroxaban increases your risk of bleeding: You should avoid activities that could cause an injury. It is usually safe to walk, jog, swim, and work in the garden. Tell your doctor or anticoagulation clinic pharmacist or nurse what your current activities are. They will tell you if it is safe to keep doing these while taking rivaroxaban. What if I get sick? Call your doctor or anticoagulation clinic if you get sick and cannot take your rivaroxaban. See What should I do if I miss a dose? on pages 2 and 3. Page 5 of 6 Treatment with Rivaroxaban
Taking rivaroxaban does not require you to avoid eating certain foods. It is best to avoid drinking alcohol while taking rivaroxaban. If you do drink, see the guidelines on page 5. Remember to tell all your health care providers that you are taking rivaroxaban. If you must stop rivaroxaban for any reason, tell the doctor who prescribed rivaroxaban for you. Who should I tell I am taking rivaroxaban? It is very important to tell all your health care providers that you are taking rivaroxaban. This includes your doctors, dentist, and all pharmacists where you have prescriptions filled. Being on rivaroxaban may affect how they care for you in certain medical situations. Carry a wallet card that says you take rivaroxaban. Consider wearing a medical alert bracelet or necklace that will tell emergency health care providers that you take rivaroxaban. Are there any times I should stop taking rivaroxaban? You may need to stop taking rivaroxaban for 1 or more days before medical or dental procedures. You must stop taking rivaroxaban before any procedure that requires you to have a tube called a catheter placed in your back for pain medicine and anesthesia. This is called an epidural catheter. If you need to stop taking rivaroxaban for any reason, call the doctor who prescribed it for you. Find out when you should stop taking it. This doctor will also tell you when to start taking rivaroxaban again after your surgery or procedure. What about pregnancy? Rivaroxaban has not been studied in pregnant women. If you become pregnant or plan to become pregnant while taking rivaroxaban, call your doctor right away to talk about the benefits and risks of taking rivaroxaban while you are pregnant. Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. Anticoagulation Clinic: 206-598-4874 University of Washington Medical Center Published PFES: 03/2013 Clinician Review: 03/2013 Reprints on Health Online: https://healthonline.washington.edu Page 6 of 6 Treatment with Rivaroxaban